Archivess of Internal MedicineDecrease in Ad Lib Smoking and Increase in Smoking Cessation Rates
Arch Intern Med. 2011;171(8):770-777. doi:10.1001/archinternmed.2011.138
Background The use of varenicline tartrate alleviates postquit withdrawal discomfort, but it also seems to reduce the “reward” associated with smoking. The current treatment schedule, which commences 1 week before quitting, relies primarily on the first mechanism. We set out to determine whether increasing the prequit medication period renders cigarettes less satisfying and facilitates quitting.
Results Varenicline preloading reduced prequit enjoyment of smoking (P = .004) and smoke intake (P < .001), with 36.7% of participants reducing their cotinine concentrations by more than 50% (reducers). Varenicline preloading did not affect postquit withdrawal symptoms, but it increased 12-week abstinence rates (47.2% in the varenicline arm vs 20.8% in the placebo arm, P = .005). The effect was particularly strong among the reducers in the varenicline arm (66.7% in reducers vs 22.6% in nonreducers, P = .002). Varenicline preloading was well tolerated.
Conclusions Although several issues remain to be clarified, varenicline preloading can generate a substantial reduction in ad lib smoking and enhance 12-week quit rates. Current treatment schedules may lead to suboptimal treatment results. Trials with longer follow-up periods are needed to corroborate these findings.
Trial Registration clinicaltrials.gov Identifier: NCT00789074
Author Affiliations: United Kingdom Centre for Tobacco Control Studies, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London (Drs Hajek and McRobbie and Ms Myers), and Cancer Research United Kingdom Health Behaviour Research Centre, University College (Mr Stapleton), and Barts and The London National Health Service Trust (Dr Dhanji), London, England.